Lecturer: Dr. Joana Salifu Yendork , Department of Psychology Contact Information: jyendork@ug.edu.gh College of Education School of Continuing and Distance Education 2014/2015 – 2016/2017
Session Overview • Just as other aspects that are affected by ageing, mental health is not spared. Minority of adults develop mental health problems that affect their daily functioning and families. In this session, the focus will be on defining mental health and psychology, problems with assessment in adults, notable risks and symptoms of mental health problems, and symptoms, causes and treatments for selected mental disorders. • Slide 2
Session Outline The key topics to be covered in the session are as follows: • Defining mental health and psychopathology • Issues of assessment in adult mental health • Risk factors and signs of mental health problems • Mental disorders: depression, dementia and delirium Slide 3
Reading List • Read Chapter 4 of Recommended Text – Adult development and aging, Cavanaugh & Blanchard-Fields (2006). Slide 4
Topic One DEFINING MENTAL HEALTH AND PSYCHOPATHOLOGY Slide 5
Defining mental health and psychopathology • Difficult to explain what is normal or abnormal behaviour • What is considered mental health depends on the circumstances under consideration • Birren and Renner (1980) describe healthy people to possess: – a positive attitude toward self – an accurate perception of reality – a mastery of the environment – autonomy – personality balance – growth – self-actualization. • Behaviours must be interpreted in context when defining normal/abnormal behaviour. Slide 6
Facts about mental health in adulthood • The majority of older individuals cope well with the physical limitations, cognitive changes, and various losses, such as bereavement, that frequently are associated with late life. • On the other hand, a substantial proportion of the population age 55 and older, almost 20% of this age group, experience specific mental disorders that are not part of “normal” aging. Slide 7
Topic Two ISSUES OF ASSESSMENT IN ADULT MENTAL HEALTH Slide 8
Assessment • Aim: helps with measurement, description, understanding and predicting behaviour • Involves gathering medical, psychological and socio-cultural information • Methods: Interviews, observation, tests and clinical examination – Method used should be reliable and valid • Multidimensional approach by team of professionals is most effective – Physician: medication regimen – Psychologists: cognitive functioning – social worker: economic and environment resources – Nurse: daily functioning skills Slide 9
Assessment • There are six primary methods of assessment – Interviews : direct and non-verbal information – Self-report : questionnaires – Report by others : family and friends – Psychophysiological assessment : relation between physical and psychological functioning • EEG (brain waves activity), heart rates, muscle activity and skin temperature • Can be used to measure the body’s reaction to stimuli such as when anxious or scared – Observation: systematic or naturalistic – Performance-based assessment • Assessment can be influenced by two main factors: – Biases: racial, ethnic, age stereotypes – Environmental conditions: where assessment occurs, sensory and mobility problems, health of the clients Slide 10
Challenges in Assessment and Diagnosis • Clinical presentation of older adults with mental disorders may be different from that of other adults, making detection of treatable illness more difficult. – More somatic complaints and experience symptoms of depression and anxiety that do not meet the full criteria for depressive or anxiety disorders. • Detection of mental disorders in older adults is further complicated by high co-morbidity with other medical disorders. • The symptoms of somatic disorders may mimic or mask psychopathology, making diagnosis more challenging. • Older individuals are more likely to report somatic symptoms than psychological ones, leading to further under identification of mental disorders. Slide 11
Topic Three RISK FACTORS AND SIGNS OF MENTAL HEALTH PROBLEMS Slide 12
Who is at risk? • Elderly individuals who: • Live alone • Are economically disadvantaged • Have no relatives or friends nearby • Have experienced recent losses • Have been ill or have a progressive or chronic illness • Have experienced a head injury causing loss of consciousness http://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf Slide 13
What should I look for? • Physical Appearance 1. Dirty clothing or skin 2. Body odor 3. Uncombed or dirty hair 4. Unshaven 5. Inappropriate clothing for the weather/situation 6. Underclothing worn over outer clothes • Emotional State • Anxious, nervous, fidgety • Lack trust, suspiciousness, blaming • Angry, hostile, irritable • Rapid mood changes • Statements such as “no one cares,” or “I’m all alone” http://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf Slide 14
What should I look for? • Personality Change • The person’s usual character or personality may seem different than earlier years… a. Decreased social contacts b. Sloppy appearance c. Lack of eye contact or excessive staring d. Excessive orderliness (to cover memory loss) or preoccupation with health • Living Conditions 1. Walks not shoveled, lawn not mowed 2. Neglect of pets or farm animals 3. Little or no food 4. Old newspapers or dirty dishes lying around 5. Calendar on wrong month 6. Shades drawn, garden/flowers neglected 7. http://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf Slide 15
Topic Four MENTAL DISORDERS: DEPRESSION, DEMENTIA AND DELIRIUM Slide 16
Common mental disorders • Depression • Delirium • Dementia • Anxiety • Psychoses • Drug Abuse and Misuse • Late-life Schizophrenia Slide 17
Prevalence of mental disorders by age Slide 18
Mental disorders: the big three • Depression, delirium and dementia have overlapping symptoms and may co-exist • Depression : one of the most common and most treatable, in older adults, but is mostly under-diagnosed and undertreated • Prevalence : 2-5% of adults of all ages meet strict criteria and 15% have some symptoms • For older adults, 1-2% with clinical depression and 16% have some symptoms (Kasl-Godley et al., 1999; Smyer & Qualls, 1999) • Rate declines across adulthood and younger adults are the most at risk • Depression co-exist with other chronic conditions, e.g., diabetes, cancer, heart conditions Slide 19
Depression: symptoms • Dysphoria : feeling down or blue • For older adults, dysphoria may present as pessimism or helplessness • Also, they may more likely show apathy (lack of interest), expressionlessness, and changes in arousal than are younger people (Reifler, 1994). • Older adults may withdraw, not speak to anyone, confine themselves to bed, and not take care of bodily functions • Younger adults may show these signs but to a lesser extent Slide 20
Depression in the Elder Population Common atypical features : • Psychotic features (paranoid delusions) • Somatization Potential Issues: • Suicide risk is high • Depression is an unusual sole cause of Vincent van Gogh, who himself cognitive impairment suffered from depression and committed suicide, painted this picture in 1890 of a man that can • Depression often co-exists with symbolize the desperation and hopelessness felt in depression. dementia Slide 21
Depression: symptoms • Physical symptoms : insomnia, changes in appetite, diffuse pain, troubled breathing, headaches, fatigue, and sensory loss (Smyer & Qualls, 1999) • These symptoms must be evaluated carefully because some may reflect normative changes that are unrelated to depression – These symptoms may also reflect underlying physical disease that is manifested in depression • Symptoms should last for at least 2 weeks • Other causes must be ruled out • Determination of the impact of symptoms on daily life Slide 22
Depression: causes • Biological theories – Genetic predisposition – changes in neurotransmitters-norepinephrine and serotonin – Abnormal brain functioning – Physical illness • Psychosocial theories – Common theme is loss – Loss could be real and irrevocable, threatened and potential or imaginary and fantasized – Likelihood vary with age e.g., middle-age adult-loss of physical attractiveness; older adults-loss of a loved one Slide 23
Depression: Causes • Cognitive-behavioural theories – Behaviour approach-depressed people engage in fewer pleasant activities and receive less pleasure from the activities – cognitive-behavioral approach emphasizes internal belief systems, which focuses on how people interpret uncontrollable events • Uncontrollable events leads to feelings of helplessness • Personally responsible for their plight • Things are unlikely to get better • Their whole life is a mess • Balance among biological dispositions, stress, and protective factors determine who develops depression (Gatz, 2000) Slide 24
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